Developing Community-Informed Communication Resources to Improve Human Papillomavirus Vaccine Uptake in Tonga.

Introduction: Despite high coverage of routine childhood vaccines, uptake of the human papillomavirus (HPV) vaccine in the Pacific Island nation of Tonga has been slow. Culturally appropriate communication resources on the importance, safety, and effectiveness of the HPV vaccine are critical to support acceptance and uptake. To develop these resources, it is important to understand what people want to know. We aimed to explore HPV vaccine information needs among communities in Tonga, to inform a tailored HPV vaccine resource to support uptake.

Methods: We conducted a two phase qualitative study involving stakeholder consultation and feedback to inform the development of a vaccine educational resource. From June to October 2023 (Phase 1), eight focus groups and one interview were conducted with 24 adolescent girls, 32 parents, 15 teachers, seven nurses, and five immunisation program staff in Nuku'alofa, Tonga. Findings informed a flip chart on the HPV vaccine which was qualitatively piloted with nine community members and nine nurses in October 2023 (Phase 2).

Results: Parents, girls, and teachers wanted clear information on the benefits and risks of the HPV vaccine. Immunisation providers lacked culturally specific resources in Tongan, and nurses requested a flip chart. All participants wanted Tongan or Pacific-specific data on HPV and cervical cancer disease burden. The flip chart was finalised in collaboration with the Tonga Ministry of Health and a local graphic designer. Piloting identified the need for training of nurses on the flip chart, and the potential for the resource to provide information to parents, school students and teachers.

Conclusion: To support HPV vaccine acceptance and uptake in Tonga, we integrated qualitative community and health provider insights to develop and pilot a culturally appropriate resource with locally designed images. Nationwide distribution will now support nurses and community leaders to share information about the HPV vaccine with their communities and additional resources will be developed for adolescent girls.